| NPI | 1194202028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS TLMLP2853) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 38815) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2023-02-27 |