| NPI | 1548935166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021039560) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS LCPC03639) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2025-02-20 |