| NPI | 1568833614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017325) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015997) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2022-09-04 |