| NPI | 1255713756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC03091) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2012026706) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2026-06-08 |