| NPI | 1710157326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 6563) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 6682) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2012-12-03 |