| NPI | 1518521236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401015071) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 19512) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2026-06-17 |