| NPI | 1568786135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC005681) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 2577) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2010-03-25 |