| NPI | 1932122090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300277) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 12096) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |