| NPI | 1518208206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 2076) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5690-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15822-131) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305108) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2019-11-05 |