| NPI | 1073566220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 0214) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 0252) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2010-11-17 |