| NPI | 1427656511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 033330) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 03207) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2021-11-03 |