| NPI | 1538920681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 30462) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 30462) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-10-29 |