NPI | 1427329143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 4866770) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MN 4866770) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303234) | |
106H00000X Marriage & Family Therapist (Licence: MN 2913) | |
Enumeration Date | 2012-01-26 |
Last Update Date | 2019-11-22 |