| NPI | 1740862036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 3090) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 1114-3-15-21A) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-12-01 |