| NPI | 1023388410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 2748) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2606427) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2026-03-10 |