| NPI | 1740437482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS LCPC 0141) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LCAC 0114) | |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2019-01-08 |