| NPI | 1265072052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 03149) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2023-05-01 |