| NPI | 1538562285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 4758) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 10336) |
| 101Y00000X Counselor (Licence: NE 2289) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2016-12-05 |