| NPI | 1932557022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC14563) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC5634) |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2016-06-01 |