| NPI | 1902296056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 173956) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LPCCCA00216570) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2026-05-22 |