| NPI | 1467628453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 00597) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MN 416809) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |