| NPI | 1811539257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A14157) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NC 980729) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |