| NPI | 1528195443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401008455) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 6401008455) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2025-05-21 |