| NPI | 1790962561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3814-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc00106) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2013-08-30 |