| NPI | 1447615794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD 16078) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MD 16078) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |