| NPI | 1326283466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4471) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010401) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2015-08-06 |