| NPI | 1568720936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 168856) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1780) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2024-03-26 |