| NPI | 1649354945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC (NC)7169) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 7169) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-01-28 |