| NPI | 1457482457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 104500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1195) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2023-12-01 |