| NPI | 1932671732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 264455) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 239851) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2021-03-30 |