| NPI | 1710763156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6851117053) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851117053) |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-09-26 |