| NPI | 1487368023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 92-152590) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |