| NPI | 1720622723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 289579) |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2024-02-02 |