| NPI | 1962446161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9557) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC2988) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-08-07 |