| NPI | 1619249521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 3654) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MS 836) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2012-02-08 |