| NPI | 1770940272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 7152) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 1898) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304281) | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2024-10-09 |