| NPI | 1114096724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 301004) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 12707) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |