| NPI | 1184983447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 1407) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 1407) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2014-04-16 |