| NPI | 1881767549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 169) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 31113) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-12-01 |