| NPI | 1124472550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 288468) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 246373) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-12-12 |