| NPI | 1871754242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 7136) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 0392) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2015-06-29 |