| NPI | 1912088469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS LCPC 059) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2893) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3543) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-01-10 |