| NPI | 1104238054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 175309) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 175309) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2024-10-29 |