| NPI | 1013479377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 293128) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 10015) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2024-07-11 |