| NPI | 1073957296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401010673) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401010673) |
| 101YP2500X Counselor Professional (Licence: MI 6401010673) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2014-12-10 |