| NPI | 1598014748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AL 3416) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL C1966A) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2016-01-26 |