| NPI | 1114013174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1957) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 1957) |
| 101YP2500X Counselor, Professional (Licence: KS 1957) | |
| 1041C0700X Social Worker, Clinical (Licence: KS 1957) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |