| NPI | 1790993798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 00165) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0406) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |