| NPI | 1629755681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 13410) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP7292) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2025-12-04 |