| NPI | 1649568213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2010040336) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 2239) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |