| NPI | 1194492025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN 3801) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 303832) |
| 101YP2500X Counselor Professional (Licence: MN 3801) | |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2024-02-20 |