| NPI | 1750706206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS 2594) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS 2608) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2018-06-11 |