| NPI | 1588253041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224061) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401018985) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2024-06-05 |