| NPI | 1598059552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 3849) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 1036) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2014-10-17 |