| NPI | 1154427631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00184) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 257) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304451) | |
| 101YP2500X Counselor, Professional (Licence: OK 1446) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2018-06-14 |