| NPI | 1134399967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC 2310) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 322) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2023-11-22 |