| NPI | 1487052494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MATTHEW GROH Owner 920-627-2793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4834-125) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |