| NPI | 1457774234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6024-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 2033 - 226) |
| 101YP2500X Counselor, Professional (Licence: MN CC3117) | |
| 101YP2500X Counselor, Professional (Licence: MN 2210) | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2023-05-02 |