| NPI | 1689559601 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224745) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401224745) |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-08-19 |