| NPI | 1447680970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 2609) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 651) |
| 101YP2500X Counselor, Professional (Licence: MO 2013005910) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2019-01-09 |