| NPI | 1144456146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4234) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 008) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 616) | |
| 104100000X Social Worker (Licence: KS 7407) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2019-02-06 |