| NPI | 1023638384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 03476) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2017017687) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-01-09 |