| NPI | 1639812209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 306145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 299824) |
| 225700000X Massage Therapist (Licence: KY 284721) | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2026-05-01 |