| NPI | 1003783721 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 2173) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7992-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304760) | |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2025-11-29 |