| NPI | 1194233809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401222421) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.1800915) |
| 101YP2500X Counselor Professional (Licence: MI 6451017189) | |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2022-01-07 |