| NPI | 1215683925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451015794) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6451015794) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2022-02-22 |