| NPI | 1538713755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6361001627) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MI 6361001627) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2024-03-27 |