| NPI | 1659625804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 665) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 391) |
| 101YP2500X Counselor, Professional (Licence: KS 03872) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2025-08-20 |