| NPI | 1720560816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 03068) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 091574) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-09-11 |