| 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 |