| NPI | 1568070811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc03766) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN cc03766) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2024-03-26 |