| NPI | 1164956223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 104133) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 104133) |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2017-04-17 |