| NPI | 1558613513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009728) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401007419) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2022-05-13 |