| NPI | 1588033591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 12141) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN cc 00946) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 301611) | |
| Enumeration Date | 2015-09-20 |
| Last Update Date | 2015-09-20 |