| NPI | 1063560365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 20572) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN LMFT #834) |
| 101YM0800X Counselor, Mental Health (Licence: MN MA LP #3316) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2021-03-10 |