| NPI | 1588482798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 00966) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 11911) |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |