| NPI | 1982787271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 1235) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 1235) |
| 101YM0800X Counselor, Mental Health (Licence: KY 1235) | |
| 106H00000X Marriage & Family Therapist (Licence: KY 1235) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-06-24 |