| NPI | 1447290374 |
|---|---|
| Former Name | ROBERT EDWARD MOE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN ADC-T) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2009-10-05 |