| NPI | 1316824287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6451024526) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6451024526) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-08-20 |