| NPI | 1770777666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 1898) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 2271) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2022-06-06 |