| NPI | 1255576609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00019) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 19) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2025-01-22 |