| NPI | 1922499078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 937) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 00937) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2023-02-23 |