| NPI | 1639895766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 2698) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID 9246) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2024-06-11 |