| NPI | 1376752972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY KY0648) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2001012918) |
| 106H00000X Marriage & Family Therapist (Licence: KY 0605) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |