| NPI | 1508049768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 245129) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 127774) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2022-04-27 |