| NPI | 1780088864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC14348) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC3626) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2015-10-18 |