| NPI | 1396355038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH18040) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304111) |
| 101YM0800X Counselor, Mental Health (Licence: MN cc02151) | |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2021-11-24 |