| NPI | 1912664079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 3240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 02336) |
| 101YP2500X Counselor, Professional (Licence: MN 02336) | |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2024-07-02 |