| NPI | 1649266388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 4954) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NE 1485) |
| 101YP2500X Counselor Professional (Licence: NE 57) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2020-12-04 |