| NPI | 1578297461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC019643) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6451022398) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2026-03-24 |