| NPI | 1942571559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 245034) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 245034) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2018-11-19 |