| NPI | 1780101188 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 309494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1862) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |