| NPI | 1639565187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018771) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc03553) |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2025-10-27 |