| NPI | 1598903445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 6904) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA 003080) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2019-05-10 |