| NPI | 1033524236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 104746) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY KY - 0223) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2016-06-06 |