| NPI | 1376312397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 105743) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY Ky0319) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-02-09 |