| NPI | 1811262546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 008627) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401012906) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2025-06-11 |