| NPI | 1669759635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012369) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 2011) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2015-04-27 |