| NPI | 1205936549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401013978) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401013978) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-07-11 |