| NPI | 1528878543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LPC04936) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS LPC04936) |
| 101YM0800X Counselor, Mental Health (Licence: KS 04396) | |
| Enumeration Date | 2025-01-10 |
| Last Update Date | 2025-04-25 |