| NPI | 1154652634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 666-9-1-10-243) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc01903) |
| 171M00000X Case Manager/Care Coordinator | |
| 101Y00000X Counselor (Licence: ND 666-9-1-10-243) | |
| 101Y00000X Counselor (Licence: MN cc01903) | |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2026-05-11 |