| NPI | 1548587322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 03307) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: MO 2017000139) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2023-06-26 |