| NPI | 1871988048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 1664) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2014018659) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2018-10-23 |