| NPI | 1548276207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC 711) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS LCMFT 680) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-09-24 |