| NPI | 1124651617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 276398) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 262441) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2022-06-01 |