| NPI | 1831492354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4473) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1772) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2010-12-06 |