| NPI | 1447923412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451017924) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 4824450) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2023-07-20 |