| NPI | 1689068850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401014735) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401014735) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-03-21 |