| NPI | 1225715097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305379) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: 10053940) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-07-03 |