| NPI | 1972121838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 288593) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 272976) |
| 101YM0800X Counselor, Mental Health (Licence: KY 286734) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2023-12-22 |