| NPI | 1508528340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223209) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6451018945) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2023-06-21 |