| NPI | 1689436461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc00013) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303387) |
| 101YS0200X Counselor, School (Licence: MN 507401) | |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-01-26 |