| NPI | 1033529813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 172294) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 1839) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2021-05-12 |