| NPI | 1376652941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401005446) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801034906) |
| 101YP2500X Counselor, Professional (Licence: MI 6401005446) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-07-10 |