| NPI | 1215641170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 12996865-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401224895) |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2025-02-13 |