| NPI | 1679906879 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224006) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401013785) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2024-07-14 |