| NPI | 1437662970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc01693) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 01905) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2020-02-25 |