| NPI | 1710576434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451017530) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6362004663) |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2023-06-02 |