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 |