| NPI | 1114125374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 104211) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY KY-0845) |
| 101YM0800X Counselor, Mental Health (Licence: KY KY-0027) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2022-05-20 |