| NPI | 1376563791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 460) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 4630-125) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-11-06 |