| NPI | 1295855963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 1217) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC3523) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-07-22 |