| NPI | 1215566757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401018236) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI SC0000000913456) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2020-05-21 |