NPI | 1700057460 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 4343) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 4126) |
Enumeration Date | 2008-03-20 |
Last Update Date | 2009-05-04 |