| NPI | 1811229354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: UT 7419004-6009) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-4334) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2010-02-09 |