| NPI | 1518295179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 102158) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 1698) |
| 101YP2500X Counselor Professional (Licence: KY 1698) | |
| 101Y00000X Counselor (Licence: KY 102158) | |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2017-01-30 |