| NPI | 1922622208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10346) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305319) |
| 101YM0800X Counselor, Mental Health (Licence: MN 2475) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-01-25 |