| NPI | 1467011130 |
|---|---|
| Former Name | KENNETH DANIEL FREEMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2019-06-06 |