| NPI | 1114411220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN CC02761) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 091290) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2022-06-01 |