| NPI | 1457893711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 28192) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305320) |
| 171M00000X Case Manager/Care Coordinator (Licence: WI 17801) | |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2022-03-30 |