| NPI | 1366282386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 291091) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 291091) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-09-27 |