| NPI | 1891343224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401225741) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401017608) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2025-11-17 |