| NPI | 1538316039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP0029) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH00011041) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2019-03-10 |