| NPI | 1548401185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: KY 3285) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 1017) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2022-10-27 |