| NPI | 1275866253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 19830) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 305091) |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2019-09-24 |