| NPI | 1669575759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 773) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 1999142227) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2010-08-17 |