| NPI | 1831419787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 05310631) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 161) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2010-06-02 |