| NPI | 1457030629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 04400-p) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2025-11-07 |