| NPI | 1750390951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401005323) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI 011191) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |