| NPI | 1538242201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 0017) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: KY 0017) |
| 106H00000X Marriage & Family Therapist (Licence: KY 0017) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-04-17 |