| NPI | 1235335290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5728) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010452) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2022-07-29 |