| NPI | 1699215798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015647) |
| 101YP2500X Counselor Professional (Licence: MI 6401015647) | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2024-08-15 |