NPI | 1417917634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00197) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN LPC-00139) |
101YP2500X Counselor, Professional (Licence: WI 2719-125) | |
Enumeration Date | 2006-03-23 |
Last Update Date | 2011-12-23 |