| NPI | 1467724187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN 2162) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 4672-125) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2023-04-14 |