| NPI | 1790933943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4326) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 344) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 104100000X Social Worker (Licence: KS 6503) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2022-08-12 |