| NPI | 1770080913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 240636) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 240636) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2025-08-08 |