| NPI | 1144823956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 265916) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 265916) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-11-03 |