| NPI | 1104071315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MA 6675) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MA 321767) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2008-12-02 |