| NPI | 1891258695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06212) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1630) |
| 104100000X Social Worker (Licence: KS 12106) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2023-09-29 |