NPI | 1437450616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 00416) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302560) |
101YM0800X Counselor, Mental Health (Licence: MN LPC00797) | |
Enumeration Date | 2010-11-04 |
Last Update Date | 2012-07-10 |