| NPI | 1619286549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 3729) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: CO 0412491) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2010-09-27 |