| NPI | 1326059197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC00031) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN 00152) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2009-05-08 |