| NPI | 1972680502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2006033192) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2320) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |