| NPI | 1205282829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 105388) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0122) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2019-06-07 |