| NPI | 1720436231 |
|---|---|
| Former Name | PAUL DAVID RUTHENBECK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303259) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2016-05-25 |