| NPI | 1932263282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 310) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 000860) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2011-09-27 |