| NPI | 1639985880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401224433) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 270750) |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-03 |