| NPI | 1639200678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC004277) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 2958) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |