| NPI | 1265719926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 105326) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL TPMF877) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2026-01-14 |