| NPI | 1144888355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 241563) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 0827) |
| 101YP2500X Counselor, Professional (Licence: KY 241563) | |
| 101YM0800X Counselor, Mental Health (Licence: KY 0827) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-07-03 |