| NPI | 1407987977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KY 1528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 617) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-06-17 |