| NPI | 1346807393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 305083) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 23736) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |