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 |