| NPI | 1720700784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 31334) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 4046) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-09-16 |