| NPI | 1609870252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 0092) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 131) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2007-07-08 |