| NPI | 1659716025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401013388) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 311795) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |