| NPI | 1619035508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 0088371) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2798-125) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-11-04 |