| NPI | 1003384843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 5689) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0016613) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2026-07-28 |