| NPI | 1346804499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401020305) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401017149) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2023-07-07 |