| NPI | 1730631581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6451024425) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301016895) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2026-05-28 |