| NPI | 1487144184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 268678) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 239987) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2021-10-29 |