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 |