| NPI | 1417174285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 104898) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 104898) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2024-03-15 |