| NPI | 1235332750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 811) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 811) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2024-05-08 |