| NPI | 1710923024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 678) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 524) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2024-05-07 |