| NPI | 1164712667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 103514) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 103514) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2024-08-01 |