| NPI | 1558091322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7333-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc04968) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2025-06-24 |