NPI | 1730380403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0004200) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4200) |
Enumeration Date | 2007-05-30 |
Last Update Date | 2021-06-10 |