| NPI | 1841664075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401006790) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401006790) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2023-01-22 |