| NPI | 1275958266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc01285) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 10739-125) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61101110) | |
| 101YM0800X Counselor, Mental Health (Licence: AK 187873) | |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2025-09-29 |