| NPI | 1316430002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc02111) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6948-125) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2019-05-09 |