| NPI | 1720583289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401016343) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401016343) |
| 101YM0800X Counselor Mental Health (Licence: 6401016343) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2020-10-13 |