| NPI | 1376318758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 258597) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 258597) |
| 101YM0800X Counselor, Mental Health (Licence: KY 258597) | |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2024-03-25 |