| NPI | 1043404262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: KS LMFT 538) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS LMFT 538) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2007-08-30 |