| NPI | 1780493213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A19314) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6451024086) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-05-30 |