| NPI | 1598967242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2006020295) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 335130-6004) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-10-08 |