| NPI | 1285727875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 0298) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 1053) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-09-03 |