| NPI | 1093336364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 5064) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0023392) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2026-07-15 |