| NPI | 1225417892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC013605) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401019019) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2023-12-04 |