| NPI | 1578796538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH9393) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL CAP2881) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2010-02-16 |