| NPI | 1851813968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 2877) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 435) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2019-04-15 |