| NPI | 1225153265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300306) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 2177-132) |
| 1041C0700X Social Worker, Clinical (Licence: WI 4188123) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |