| NPI | 1306393533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401017563) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MI 6401017563) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2024-01-16 |