| NPI | 1801387691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401019275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401016670) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2021-10-25 |