| NPI | 1467147785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 012037) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401223181) |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2023-04-11 |