| NPI | 1043590979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 852) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 2402) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2020-03-19 |