| NPI | 1962181123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC03966) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-09-12 |