| NPI | 1891239109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 10278) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 276) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2018-09-25 |