| NPI | 1811930993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 015) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 0110) |
| 101YM0800X Counselor, Mental Health (Licence: KS 326) | |
| 101YP2500X Counselor, Professional (Licence: KS 326) | |
| 103TC1900X Psychologist, Counseling (Licence: KS 0110) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-02-06 |