| NPI | 1922165786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC2252) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD ATC009) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2017-02-24 |