| NPI | 1790806305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY KY1581) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY KY0305) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2013-10-30 |