| NPI | 1932375847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5148) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 3453) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2015-04-16 |