| NPI | 1487200648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 3119) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 00956) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2021-08-05 |