| NPI | 1679778112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2000151807) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 056) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-08 |