| NPI | 1467717850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 00717) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 01180) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2014-04-21 |