| NPI | 1386028199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN 01041) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MN 1547) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2018-03-17 |