| NPI | 1841816477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 03642) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 101595) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2026-02-06 |