| NPI | 1457654915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 99053159A) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY KY-1285) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2012-08-28 |