| NPI | 1952036790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 89234) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401225074) |
| 101YP2500X Counselor, Professional (Licence: WI 11651-125) | |
| Enumeration Date | 2022-07-17 |
| Last Update Date | 2026-07-28 |