| NPI | 1316341175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401014521) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401014521) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2018-08-29 |