| NPI | 1659820454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019176) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401016868) |
| 247200000X Technician, Other | |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2021-04-20 |