| NPI | 1144467697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401012158) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC1074) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2026-05-22 |