| NPI | 1992946487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY LPCPCC00218334) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2015-07-08 |