| NPI | 1457991549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN 2330) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2330) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-03-25 |