| NPI | 1801206610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4314) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 859) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |