| NPI | 1053023150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451022757) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2023-01-03 |