| NPI | 1821952359 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 5335) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 12153-125) |
| Enumeration Date | 2025-12-10 |
| Last Update Date | 2025-12-10 |