| NPI | 1295486777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451019817) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6451019817) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2022-01-15 |
| Last Update Date | 2024-09-26 |