| NPI | 1447146725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451024219) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI SC0000001098277) |
| Enumeration Date | 2025-06-14 |
| Last Update Date | 2025-07-17 |