| NPI | 1124875976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451023573) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021405) |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-08-07 |