| NPI | 1104001726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401012429) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6803085803) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2020-07-07 |