| NPI | 1124177464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 106701) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 0641) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-05-23 |