| NPI | 1629388772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 105712) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 170523) |
| 101YP2500X Counselor Professional (Licence: WV 2505) | |
| 101YP2500X Counselor Professional (Licence: KY 1093) | |
| 101YP2500X Counselor Professional (Licence: KY 105712) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2024-07-12 |