| NPI | 1235726951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1930) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305109) |
| 101YP2500X Counselor, Professional (Licence: MN 03076) | |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2025-06-09 |