| NPI | 1265839351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401014345) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401014345) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2026-04-27 |