| NPI | 1124162334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 103176) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 103176) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2022-07-20 |