| NPI | 1881004620 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223142) | 
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401223142) | 
| Enumeration Date | 2014-05-01 | 
| Last Update Date | 2025-06-12 |