| NPI | 1508519315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor School (Licence: AZ 3316887) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AZ 10667) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |