| NPI | 1619748100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC03865) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-159706-051) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-11-25 |