| NPI | 1558565739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 173071) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 0114) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2018-07-26 |