| NPI | 1912335399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY LPCPCC00218886) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LPCPCC00218886) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2022-04-05 |