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 |