| 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 |