| NPI | 1962517359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 3054) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS LCPC03925) |
| 101YP2500X Counselor, Professional (Licence: CO 4901) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2026-03-06 |