| NPI | 1871839241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5637) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 1501) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2014-02-04 |