| NPI | 1609308220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc01494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1494) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2018-03-17 |