| NPI | 1487082350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4796) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 4796) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1326) | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist (Licence: KS 2866) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2020-09-29 |