| NPI | 1750653861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5465) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A8467) |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2013-01-26 |