| NPI | 1063456721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS 1438) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 0157) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 130) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-01-24 |