| NPI | 1639780828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021035831) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2021-12-07 |