| NPI | 1235262148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 104933) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0195) |
| 101YP2500X Counselor, Professional (Licence: MD LC3547) | |
| 101YP2500X Counselor, Professional (Licence: KY 104707) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2018-03-22 |