| NPI | 1043758808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 00223665) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KY 0875) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2023-03-07 |