| NPI | 1326685645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 304057) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 18513) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2019-12-05 |