| NPI | 1568534790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39003780A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401225457) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6361005531) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2025-08-29 |