| NPI | 1760281331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KS 03405) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 03405) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-08-06 |