| NPI | 1609536176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: 6401000080) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MI 64010000080) |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2021-12-27 |