NPI | 1417558321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN LP6609) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP6609) |
Enumeration Date | 2020-11-06 |
Last Update Date | 2024-12-06 |