| NPI | 1710158308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018728) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 12618) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2022-02-19 |