| NPI | 1295124527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 168684) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 141136) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 168267) | |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2016-07-28 |