| NPI | 1629502406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401015217) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015217) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-08-14 |