| NPI | 1831815414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 03470) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS LMFT03430) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2023-02-07 |