| NPI | 1902195118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5255) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: LA AN 469600) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-11-23 |