| NPI | 1760913404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259185) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 272984) |
| 104100000X Social Worker (Licence: KY 255946) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-05-30 |