| NPI | 1871845834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9428) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 290573) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2024-02-21 |