| NPI | 1336491372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC A9664) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: VA SOE-0608178) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |