| NPI | 1083081699 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 11758) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2021-12-08 |