| NPI | 1184029340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401005523) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 00014088) |
| 101YS0200X Counselor, School (Licence: MI MI-SC0000000749838) | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2018-09-20 |