| NPI | 1508267071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 163170) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY E.1600008-SUPV) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2025-04-24 |