| NPI | 1487890539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 03002) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 6791) |
| 101YP2500X Counselor, Professional (Licence: MO 2007034754) | |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2022-03-14 |