| 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 |