| NPI | 1598043903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KS T-LPC2281) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: KS T-LPC2281) |
| 106H00000X Marriage & Family Therapist (Licence: KS T-LPC2281) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2011-08-02 |