| NPI | 1124271986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018215) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010834) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2020-03-31 |