| NPI | 1477967420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1152) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 114) |
| 101YP2500X Counselor, Professional (Licence: KS 2619) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-12-04 |