| NPI | 1427400977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY KSWB-5155) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY KSWB-5155) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY CADCB-165614) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2023-04-17 |