NPI | 1174048839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 266) |
Additional Taxonomies | 104100000X Social Worker (Licence: KS 10229) |
Enumeration Date | 2017-08-03 |
Last Update Date | 2022-07-21 |