| NPI | 1730909151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6451023165) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6362009771) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |