| NPI | 1003081779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN LPC00626) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN LPP 0124) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-11-13 |