| NPI | 1558638015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM 0138681) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0138681) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |