| NPI | 1780869446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 2485) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 919) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 504) | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2026-01-14 |