| NPI | 1396185625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 301) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8400) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2025-03-18 |