| NPI | 1679892103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 705) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401009081) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2012-10-16 |