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 |