| NPI | 1205026358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY ADCLAD00223658) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY LPCCCA00216363) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2016-05-05 |