| NPI | 1508876962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 13997) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 13662) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-03-25 |