| NPI | 1588907109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN CC01686) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2022-03-01 |