| NPI | 1649477464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 1293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1293) |
| 101YP2500X Counselor, Professional (Licence: KY 0577) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2024-02-12 |