| NPI | 1518353630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401007857) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2019-03-02 |