| NPI | 1861745903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 03241) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 2415) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2023-01-06 |