| NPI | 1124565833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: MO 0441047) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2013002018) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-01-20 |