| NPI | 1447672068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC007680) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E0002442) |
| 101YP2500X Counselor Professional (Licence: KY 0157) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |