| NPI | 1881608081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 642 and 643) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 106H00000X Marriage & Family Therapist (Licence: KS 677) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |