| NPI | 1851623383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 94) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS 109) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2021-04-09 |