| NPI | 1124451141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401018116) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401012911) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2020-08-12 |