| NPI | 1306200704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401014958) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401014958) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-03-21 |