| NPI | 1417245770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC8334) |
| 101YP2500X Counselor, Professional (Licence: CT 9687) | |
| 101YP2500X Counselor, Professional (Licence: ME CC8901) | |
| 101Y00000X Counselor (Licence: MI 6401002606) | |
| 101YP2500X Counselor, Professional (Licence: WA MHC.LH.70136092) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2026-09-05 |