| 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 |