| NPI | 1609204429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 6285) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A10380) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2016-09-20 |