| 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 |