| 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 |