| NPI | 1619284346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC2366) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14057) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |