| NPI | 1447680699 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019310) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401012730) |
| Enumeration Date | 2013-11-24 |
| Last Update Date | 2021-10-14 |