| NPI | 1871046839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401015524) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401015524) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2018-08-20 |