| NPI | 1205206927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451014313) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: MI 6451014313) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-12-19 |