| NPI | 1487536272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LPC04359) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LMAC01288) |
| Enumeration Date | 2025-07-22 |
| Last Update Date | 2025-07-22 |