| NPI | 1518076017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 2388) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701003512) |
| 101YP2500X Counselor, Professional (Licence: OH E2680) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-03-28 |