| NPI | 1821211426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc02907) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 3706 125) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2023-09-27 |