| NPI | 1447495353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 0198) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 1426) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2008-12-05 |