| NPI | 1568244986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MN CC04053) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MN CC04053) |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2023-10-19 |