| NPI | 1336517721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3873) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 1452) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2024-06-25 |