| NPI | 1720296023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS 114) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 97) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-04-17 |