| NPI | 1023465614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401015498) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-04-25 |