| NPI | 1770781825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 5953) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 3032) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2017-01-18 |