| NPI | 1497292684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc01465) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303750) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.012732) | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2022-07-13 |