| NPI | 1972653772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 103018) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 1182) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2021-07-13 |