| NPI | 1447641972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 248063) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY LPCCCA00216616) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2022-05-17 |