| NPI | 1578129680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401222525) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-07-25 |