| NPI | 1881289296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 03695) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 3604) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-03-08 |