| NPI | 1104882935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 168-11-15-01-148) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 00053) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-09-06 |