| NPI | 1043774466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI N352059) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401222320) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2025-07-25 |