NPI | 1407227952 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 242014) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 242014) |
Enumeration Date | 2015-10-09 |
Last Update Date | 2020-05-06 |