| NPI | 1194392332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC03986) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2019047041) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2025-05-15 |