| NPI | 1952789307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2015009922) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS LCPC03318) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-02-14 |