| NPI | 1730248626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 684) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2002008097) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-09-07 |