| NPI | 1154670735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019625) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401019625) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0003379) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-05-28 |