NPI | 1417245770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002606) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401002606) |
Enumeration Date | 2011-07-20 |
Last Update Date | 2025-05-30 |