| NPI | 1225364177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 768) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 2055) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 044) | |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2011-09-12 |