| NPI | 1881978807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 166819) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 0964) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2018-06-08 |