| NPI | 1972200939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451022406) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2025-07-10 |