| NPI | 1447797683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 166675) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 282114) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 265345) | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2023-01-24 |