| NPI | 1164893699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4877) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 4877) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 001) | |
| 101YM0800X Counselor, Mental Health (Licence: KS 4877) | |
| 101YP1600X Counselor, Pastoral | |
| 104100000X Social Worker (Licence: KS 4877) | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2019-03-19 |