| NPI | 1750897799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017519) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401016435) |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2025-05-06 |