| NPI | 1891202818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 267298) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 267298) |
| 101YM0800X Counselor, Mental Health (Licence: KY 267298) | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2024-12-10 |