| NPI | 1548555725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 875) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 2340) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2014-10-27 |