| NPI | 1366835712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 3694) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: CT 013) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2019-03-19 |