| NPI | 1124653290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 3346) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305429) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP.0100806) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH21654) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2023-08-02 |