| NPI | 1194264549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: MN 902963300022) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2021-10-25 |