| NPI | 1720461668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc01973) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 01682) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2019-10-25 |