| NPI | 1639565187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MN 472831) |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2015-04-11 |