NPI | 1760750921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 28771) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 24431) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 301886) | |
Enumeration Date | 2011-12-02 |
Last Update Date | 2021-01-13 |