| NPI | 1942516299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 4975) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 5673) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2018-06-18 |