| NPI | 1770871972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS T1234) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106H00000X Marriage & Family Therapist (Licence: KS 2337) | |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2022-11-06 |