| NPI | 1154131555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 4773) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 12402-125) |
| 101YM0800X Counselor, Mental Health (Licence: IA 137624) | |
| 101YM0800X Counselor, Mental Health (Licence: MN 4773) | |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC6971) | |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2026-05-01 |