| NPI | 1346704871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 25684) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305024) |
| 1041C0700X Social Worker, Clinical (Licence: TX 66817) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2021-06-15 |