| NPI | 1104997576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 103351) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0612) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2018-08-30 |