| NPI | 1154743607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 1061) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 1360) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2019-06-28 |