| NPI | 1891153300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 248717) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY LPCCCA00224178) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2023-04-12 |