| NPI | 1356816631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4972) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 00776) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 8091) | |
| 1041C0700X Social Worker, Clinical (Licence: MO 2017042408) | |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2026-05-20 |