| NPI | 1578179537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 03254) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 03186-T) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2021-09-17 |