| NPI | 1699492959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401223033) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401223033) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-01-07 |