| NPI | 1578113536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 640107454) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2022036739) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2024-07-16 |