| NPI | 1134671688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 175424) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 168328) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2018-10-02 |