| NPI | 1548437379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1472) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2007036771) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2016-04-29 |