| NPI | 1215977319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 104182) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0180) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2018-03-30 |