| NPI | 1598903544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7284) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 6110) |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2018-11-08 |