| NPI | 1295372001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 693-7-15-277) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc03258) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1662) | |
| Enumeration Date | 2019-12-01 |
| Last Update Date | 2026-01-02 |