| NPI | 1063040863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401223673) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401017823) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2023-08-08 |