| NPI | 1215085600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 1498) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY ADCLAD0022409) |
| 104100000X Social Worker (Licence: KY 1498) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-04-25 |