| NPI | 1518506963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401014330) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401014330) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2021-09-08 |