| NPI | 1083246573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: MI 6401016633) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 640108438) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2024-10-23 |