| NPI | 1891899035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 103108) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 0487) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-05-24 |