| NPI | 1326884750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 03184) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305506) |
| 101YM0800X Counselor, Mental Health (Licence: MN 3184) | |
| Enumeration Date | 2024-07-04 |
| Last Update Date | 2024-07-30 |