| NPI | 1689779738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS RAODAC 26) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS LSCSW 930) |
| 1041C0700X Social Worker Clinical (Licence: MO LCSW 4705) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |