| NPI | 1386069565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC2452) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO LPC2015015355) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0012304) | |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2016-06-25 |