| NPI | 1457411654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0015268) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 1335) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-04-02 |