| 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 |