| NPI | 1740363324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 1368) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 1368) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 1368) | |
| 101YM0800X Counselor, Mental Health (Licence: KY 1368) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-07-13 |