| NPI | 1356586408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401010208) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2025-07-02 |