| NPI | 1043800956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401223573) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: MI 6401019007) | |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2024-10-28 |