| NPI | 1770183956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223053) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401018742) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2022-11-08 |