| NPI | 1871714972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 103886) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY KY-1321) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2016-12-12 |