| NPI | 1083180848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401016786) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401016786) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |