| NPI | 1184887267 |
|---|---|
| Former Name | JEFFERY AGATON PUERNER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18394) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303029) |
| 104100000X Social Worker (Licence: MN 18394) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2022-11-08 |