| NPI | 1770652281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KS 075) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2002012681) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |