| NPI | 1538484001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 8113) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC005643) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2013-03-09 |