| NPI | 1558828251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 5190) |
| 101YP2500X Counselor, Professional (Licence: PA 200579837) | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2026-03-02 |