| NPI | 1770953754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 286487) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: KY 174528) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2025-03-26 |