| NPI | 1831508985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 10666) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC2550) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2014-08-02 |