| NPI | 1275704777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401010326) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010326) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2019-05-06 |