| 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 |