| NPI | 1225814684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc02262) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5269-125) |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2023-09-01 |