| NPI | 1215630421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451022822) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI SC0000001110731) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-03-24 |