| NPI | 1295482800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 12322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 4934) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2026-07-01 |