| NPI | 1508459462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC03062) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-11-12 |