| NPI | 1467960922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019819) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401016442) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2024-07-09 |