| NPI | 1336617844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401017476) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401017476) |
| 101YM0800X Counselor, Mental Health (Licence: CA 5341) | |
| 101YM0800X Counselor, Mental Health (Licence: CA LPCC10248) | |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2022-08-04 |