| NPI | 1922252154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS LPC 876) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: KS 6445167659) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |