| NPI | 1033588785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 174276) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 251818) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2023-12-11 |