| NPI | 1396341186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 0011181) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: CO 182781) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |