| NPI | 1043376635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: 1763 & 302151) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 302151) |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 101YP2500X Counselor Professional (Licence: MN #1763 LMFT) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: #302151) | |
| 101YP1600X Counselor Pastoral | |
| 101YP2500X Counselor Professional | |
| 251S00000X Community/Behavioral Health (Licence: 1763) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2010-03-17 |