| NPI | 1467901496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 264409) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 264409) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 272855) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2025-06-04 |