| NPI | 1518361492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1200) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 9328) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2016-01-07 |