| NPI | 1982072765 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 02015) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01085) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303944) | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2022-08-01 |