| NPI | 1598257966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401017013) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401017013) |
| 103TC1900X Psychologist Counseling (Licence: MI 6301017455) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2021-01-06 |