| NPI | 1336573773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252368) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY ADCLAD00223222) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2017-02-08 |