| NPI | 1649742792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019644) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401017085) |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2021-08-24 |