| NPI | 1033364724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC780) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2007025935) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2010-08-10 |