NPI | 1477074862 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 254229) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 165997) |
Enumeration Date | 2017-07-06 |
Last Update Date | 2022-07-21 |