| NPI | 1194615419 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 5054) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306348) |
| 101YM0800X Counselor, Mental Health (Licence: MN 5054) | |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |