| NPI | 1497928758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: FL 612192) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 612192) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |