| NPI | 1790054708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9051) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A9051) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2017-05-25 |