| NPI | 1417558321 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| 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 |