| NPI | 1023395159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 006560) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401008811) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |