| NPI | 1942578166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75386) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401012293) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2026-06-03 |