NPI | 1598120495 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 243217) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY LPCCCA00223737) |
Enumeration Date | 2015-12-18 |
Last Update Date | 2024-03-25 |