| NPI | 1477969467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 4662) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 10086) |
| 101Y00000X Counselor (Licence: NE 505) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2015-11-10 |