| NPI | 1710938782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY KY-1524) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN LPC0000000736) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-06-04 |