| NPI | 1548496144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2130) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC003819) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2009-06-09 |