| NPI | 1164222790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor School |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: 210228520) |
| 101YS0200X Counselor School (Licence: CA 210228520) | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-03-13 |