| NPI | 1851627236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 3551) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 00001656) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |