| NPI | 1154735454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LMAC437) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1053) |
| 104100000X Social Worker (Licence: KS LMSW10391) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-02-09 |