| NPI | 1255751269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 164566) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY LPCPCC00225355) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2018-08-08 |