| NPI | 1386835395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 319) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 801) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2020-10-26 |