| NPI | 1912458308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017490) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401015678) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2020-05-26 |