| NPI | 1336855956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451022677) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH28308) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2026-08-18 |