| NPI | 1831735141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 2463) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 12348521-6004) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2025-06-13 |