| NPI | 1992113807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 03177) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 03177) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 03177) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 10047) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2021-12-21 |