| NPI | 1346622412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 23714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 19500) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |