| NPI | 1437545878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 243502) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 00216563) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2019-02-20 |