| NPI | 1730526013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401012920) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401012920) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2021-01-25 |