| NPI | 1437620978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401019020) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401019020) |
| 101YP2500X Counselor, Professional (Licence: MI 6401016944) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2021-01-28 |