| NPI | 1013180223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4624) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: CO 0375653) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-04-09 |