| NPI | 1437661899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 240673) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY ADCADT00222882) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2022-07-01 |