| NPI | 1639642044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401223380) |
| Additional Taxonomies | 101Y00000X Counselor |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-05-13 |