| NPI | 1154028264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 280457) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 280457) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2025-03-18 |