| NPI | 1669672069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0774) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2024-10-14 |