| NPI | 1215390265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401224555) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401224555) |
| 101YM0800X Counselor, Mental Health (Licence: OK 12387) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2026-04-01 |