| NPI | 1629611512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 280398) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 280398) |
| 101YP2500X Counselor, Professional (Licence: KY 265747) | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-02-29 |