| NPI | 1003514019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6451022802) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6362009701) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-06-19 |