| NPI | 1649880170 |
|---|---|
| Professional Name | BRADLEY ALLEN SANSOM |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 244702) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2022-04-04 |