| NPI | 1417232505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18890) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303057) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1636) | |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2022-01-27 |