| NPI | 1588971907 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2006037997)  | 
| Additional Taxonomies | 101YP2500X Counselor, Professional | 
| Enumeration Date | 2010-09-07 | 
| Last Update Date | 2016-08-10 |