| NPI | 1902196579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 553) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 553) |
| 101YP2500X Counselor, Professional (Licence: MN 553) | |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2016-11-18 |