| NPI | 1306700851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 100588) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6451022672) |
| Enumeration Date | 2025-12-10 |
| Last Update Date | 2025-12-10 |