| NPI | 1659705580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 169078) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 247698) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 1183) | |
| 171M00000X Case Manager/Care Coordinator (Licence: KY 1183) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2024-09-12 |