| NPI | 1275290876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401223881) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401223881) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2026-08-19 |