| NPI | 1386284149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224194) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401017729) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2024-04-19 |