| NPI | 1083257067 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401222304) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401017730) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2022-08-05 |