| NPI | 1134794183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 03323) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 03212-T) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2021-10-30 |