| NPI | 1851753891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 0016671) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MI 6401014972) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-11-09 |