| NPI | 1205052461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 0564) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 0003) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2025-09-11 |