| NPI | 1427329143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN 4866770) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 4866770) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 303234) | |
| 106H00000X Marriage & Family Therapist (Licence: MN 2913) | |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2019-11-22 |