| NPI | 1770878282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5340-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401012474) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2015-09-25 |