NPI | 1285237917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 3542) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304985) |
101YM0800X Counselor, Mental Health (Licence: MN 3542) | |
Enumeration Date | 2020-11-17 |
Last Update Date | 2025-05-07 |