| NPI | 1922513894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223314) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2017042234) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2023-07-12 |