| NPI | 1851427074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI J 250 367 390 278) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI J 250 367 390 278) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |