| NPI | 1285498071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 246305) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 281200) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |