| NPI | 1366612624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 1359) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY KY-0839) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2014-06-16 |