| NPI | 1568616118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 4694) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY KY 1667) |
| 101YM0800X Counselor, Mental Health (Licence: KY 104445) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2021-11-10 |