| NPI | 1609202035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 5826) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 1871-226) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2016-07-26 |