| NPI | 1124244280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 0427) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: KY 0035) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-06-28 |