| NPI | 1992118079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KS 2549) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 2454) |
| 101YP1600X Counselor Pastoral (Licence: KS 2454) | |
| 101YP2500X Counselor Professional (Licence: KS 2454) | |
| 1041C0700X Social Worker Clinical (Licence: KS 2549) | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2020-02-13 |