| NPI | 1841455748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 4190) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS AAPS CERTIFICATION) |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2022-04-11 |