| NPI | 1780952820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS 2241) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 1248) |
| Enumeration Date | 2011-12-04 |
| Last Update Date | 2011-12-04 |