| NPI | 1922177880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 0065) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 020) |
| 106H00000X Marriage & Family Therapist (Licence: MO 300113) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |