| NPI | 1134156961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 1881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 221700000X Art Therapist (Licence: KS 14871) | |
| 221700000X Art Therapist (Licence: MO 14871) | |
| 106H00000X Marriage & Family Therapist (Licence: KS 113957) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 113957) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2009-10-22 |