| NPI | 1225397888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY LPCPCC00211320) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 1372) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2026-08-13 |