| NPI | 1760804140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401013072) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI PF0000000779738) |
| Enumeration Date | 2014-01-20 |
| Last Update Date | 2014-01-20 |