| NPI | 1417493354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 255374) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 255374) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 165293) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2021-03-31 |