| NPI | 1679898894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN LPC00922) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 3103) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2014-03-26 |