| NPI | 1891928198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC60230791) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6451022402) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2023-03-15 |