| NPI | 1689747099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3828-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 419) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2012-12-31 |