NPI | 1063930238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304904) |
Additional Taxonomies | 183500000X Pharmacist (Licence: MN 116734) |
183500000X Pharmacist (Licence: SD 4890) | |
Enumeration Date | 2017-09-07 |
Last Update Date | 2017-09-07 |