| NPI | 1891737029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS LSCSW 3660) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS RAODAC 137) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ LISAC-10175) | |
| 1041C0700X Social Worker Clinical (Licence: AZ LCSW-10218) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |