| NPI | 1578875902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401011789) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 1105910) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2013-07-12 |