| NPI | 1164867297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401013621) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401013621) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-05-18 |