| NPI | 1225550403 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401018485) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401016188) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2022-07-21 |