| NPI | 1831842137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 295190) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 260216) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2025-01-07 |