| NPI | 1649623083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 1682) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 3088 - 226) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2025-10-10 |