| NPI | 1689849614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 279211) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1036) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-09-07 |