| NPI | 1962070763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 304393) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401019428) |
| 101YP2500X Counselor, Professional (Licence: MI 6401019428) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2026-01-30 |