| NPI | 1972826220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 415-051-0000) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 415-051-0130) |
| 101Y00000X Counselor (Licence: OR 415-054-0005) | |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-01 |