| NPI | 1649712001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 23421) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303335) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2019-04-25 |