NPI | 1114568763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303229) |
Additional Taxonomies | 104100000X Social Worker (Licence: MN 26330) |
Enumeration Date | 2019-10-04 |
Last Update Date | 2019-10-04 |