| NPI | 1750892527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 268963) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 246330) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2022-01-10 |