| NPI | 1073707147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN CC00038) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN CC00038) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2010-06-30 |