| NPI | 1043862444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPCC.0015361) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: CO 205597) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-15 |