| NPI | 1215504253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 6667) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 6667) |
| 101YS0200X Counselor School (Licence: LA 458459) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-06-08 |