| NPI | 1619560554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305958) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 305958) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |