| NPI | 1730227273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS MFT 312) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2004019045) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2007-07-08 |