| NPI | 1013562420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223799) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401223799) |
| Enumeration Date | 2019-08-03 |
| Last Update Date | 2024-11-07 |