| NPI | 1902068976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC3786) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME XL3399) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2012-05-25 |