| NPI | 1861662751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1799) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C1799) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2020-11-10 |