NPI | 1801436688 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: MN CC02273) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7848-125) |
Enumeration Date | 2020-01-09 |
Last Update Date | 2024-05-15 |