| NPI | 1285183301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014632) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc01352) |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2019-05-31 |