| NPI | 1053882894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN CC01991) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2022-05-26 |