| NPI | 1043526635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 01361) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 00945) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2021-03-31 |