| NPI | 1821752445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451017498) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401222343) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2022-10-26 |