| NPI | 1396193538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4993) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 294) |
| 104100000X Social Worker (Licence: KS 9954) | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2019-07-26 |