| NPI | 1386066512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY KY-1621) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY KY-1621) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2015-10-20 |