| NPI | 1265902837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A14323) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NC 1213460) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |