| NPI | 1043436942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303094) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 2206) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2014-07-23 |