| NPI | 1639328644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 4910) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 36) |
| 101YM0800X Counselor, Mental Health (Licence: KS 750) | |
| 101YP2500X Counselor, Professional (Licence: KS 750) | |
| 225C00000X Rehabilitation Counselor (Licence: IL 205027) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2020-05-09 |