| 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: GA LPC017164) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401017608) | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2026-08-24 |