| NPI | 1992975577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1394) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 11623) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2017-01-27 |