| NPI | 1336295369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 104511) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 379) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-04-21 |