| NPI | 1043492176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401008162) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2025-10-01 |