| NPI | 1447745922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 163417) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 245379) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-10-31 |