| NPI | 1790249787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 294724) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 294724) |
| 101YS0200X Counselor School (Licence: KY 201202269) | |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2025-08-26 |