| NPI | 1073749982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 7410) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 05301) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2021-06-09 |