| NPI | 1760532196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 005591) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 3171) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2015-12-16 |