| NPI | 1598206203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 22975) |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2024-02-05 |