| NPI | 1053967737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 03105) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 3066) |
| Enumeration Date | 2019-08-17 |
| Last Update Date | 2022-04-19 |