| NPI | 1982215703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6801108235) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801108235) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2024-07-15 |