| NPI | 1699433342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306411) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MN 5670) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2026-07-02 |