| NPI | 1780611970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0181) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2015-10-13 |