| NPI | 1790249787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KY 294724) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: KY 201202269) |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2024-10-17 |