| NPI | 1235585373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401000688) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PR 2477) |
| Enumeration Date | 2016-05-08 |
| Last Update Date | 2016-05-08 |