| NPI | 1710082896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL LPCAL1377) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH8530) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |