NPI | 1649631250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc01175) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc01175) |
Enumeration Date | 2016-03-09 |
Last Update Date | 2024-06-07 |