| NPI | 1740338805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6449) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC LPC7276) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-10-02 |