| NPI | 1629615299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LPCCCA00218290) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2020-12-09 |