NPI | 1275820128 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002902) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2011-06-29 |
Last Update Date | 2024-02-05 |