| NPI | 1942212154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6950) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 01387) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-09-08 |