| NPI | 1710913488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC0685) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: DC PRC936) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2016-10-03 |