| NPI | 1982199717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018523) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401016700) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2021-06-25 |