| NPI | 1861867475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401015132) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401015132) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2018-12-21 |