| NPI | 1740561141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 103835) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 170819) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2021-04-13 |