| NPI | 1093288987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc03838) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN cc03838) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305266) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2024-05-31 |