| NPI | 1508549783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc02047) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2047) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2025-08-04 |