| NPI | 1437554581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4675) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR R2739) |
| 101YS0200X Counselor, School (Licence: OR 143715) | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2022-03-16 |