| NPI | 1265150536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6362009584) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-06-20 |