| NPI | 1205454220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 282336) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 264268) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2023-05-08 |